Account and Financial Management Journal e-ISSN: 2456-3374 Volume 4 Issue 12 December- 2019, (Page No.-2048-2053) DOI: 10.33826/afmj/v4i12.01, I.F. - 4.614

© 2019, AFMJ

Comparative Expected Value Analysis Study on Programs, Treatments, Medications and Products Reducing the Prevalence of , Alcoholism, Depression and Obesity in the United States

S. Eric Anderson1, Morgan Redal2, Lorraine Abaro Thomas3, Ginny Sim4, Brooke Campbell5 1,2,3,4,5La Sierra University, Riverside California

ABSTRACT: It was determined that medication provided the most value reducing the prevalence of smoking, alcoholism, and obesity, while exercise provided the most value treating depression. Value was determined by dividing treatment cost with success rate. Medication provided the most value reducing the prevalence of alcoholism followed by Alcoholics Anonymous, outpatient drug free treatment, , gum, , Chantix, nasal spray and nicotine inhaler. Acupuncture, lozenges, strips, sticks and laser therapy were not effective treatment options. Medication provided the most value in weight loss followed by liposuction, personal trainer and lap band. Exercise and meditation provided the most value reducing the prevalence of depression followed by medication, support groups and psychotherapy. KEYWORDS: Alcoholism, Depression, Expected Value Analysis, Obesity, Smoking Cessation

INTRODUCTION Chronic conditions such as ischaemic heart disease and Ninety percent of the $3.5 billion spent on healthcare cancers (predominantly lung cancer) have caused health expenditures in the United States are for chronic and mental problems in regular smokers (1-4 per day). A health conditions (Burtoff, 2017). Hafner (2016) reported study comparing regular smokers to non-smokers found that 21 million suffer from some type of and only increased health risks due to long term smoking 10% of Americans suffering from addiction get the (Bjartveit&Tverdal, 2005). This leads to higher healthcare treatment they need for it. Also, twenty percent of costs for medications and treatments over an individual's Americans that suffer from depression resort to substance lifetime. Obesity alone, on average, can age an individual abuse (Addiction Statistics, 2019). Alcohol and drug twenty years. Obesity also causes chronic health conditions addiction costs the United States $600 billion every year. In (Strum, 2002). These conditions can cause a 36% increase the past 20 years over 700,000 Americans have died from a in spending for a hospital. An obese individual may also drug overdose. The Centers for Disease Control and cause a 77% increase in costs just for medications. Prevention (2018) reported that the cost of excessive alcohol A long term side effect of depression would be its increased use in the United States reached $249 billion in 2010.This mortality rate on those with Diabetes. A study found that study will conduct a comparative expected value analysis to major depression was significantly associated with mortality determine the effectiveness of programs, treatments, compared to minor depression which was nonsignificant medications and products reducing the prevalence of (Lin, et al., 2009). Results suggested that previously smoking, alcoholism, depression and obesity in the United diagnosed depression and diabetes patients have a States. significantly higher risk of mortality after recurrent Alcoholism, smoking, obesity and depression not only cause depression. health issues but can be costly over time. The prevalence of These risks to individuals not only negatively impact their this study reports the best treatments of each condition and health, but lead to costly treatments and medications. preventative treatments which were valued based on their Smoking, alcoholism, depression and obesity in the United success rate. The excessive consumption of alcohol has led States threaten the health long term wellbeing of patients. to fatality, disease and injury, alcohol related crimes and The purpose of this study was to determine the success rates motor vehicle accidents (Bouchery, E. E., et al., 2011). of programs used to treat these conditions to overall benefit Premature due to alcoholism has been estimated on the affected individual. average to be 79,000 deaths annually. The cost alone in the United States back in 2006 for excessive drinking was about Alcoholism Program Costs and Success Rates $746 per individual. The cost for the 12step Alcoholics Anonymous program can be around a $250 donation,and the American Society of 2048 S. Eric Anderson1, AFMJ Volume 4 Issue 12 December 2019

“Determination of Company Profitability and Value of Banks in Indonesia Based on Risk Profile, Capital Structure, Corporate Governance and Asset Structure” Addiction Medicine (2015) reported that approximately 10% treatment of problems caused by excessive drinking (11%), of the people enjoy long term success in their recovery. law enforcement and other criminal justice expenses (10%) Outpatient drug-free programs cost $1,200 and 18% remain and losses from motor vehicle crashes related to excessive sober after five years (Juergens, 2019). alcohol use (5%). Therefore, the total cost of excessive alcohol consumption was $69.72 billion ($249 billion * .28) The price for medication to treat alcoholism (naltrexone) not including workplace productivity. According to the varies from $25 to $60 per month and the treatment typically Office of Management and Budget (2019) the excise tax lasts for three months for an average cost of around $150. revenue from alcoholic beverages amounted to $9.9 billion According to the National Institute of Alcohol Abuse and in 2017, which resulted in a net cost of $59.82 billion. Alcoholism around 20 – 25% of those receiving medication According to the Substance Abuse Mental Health Service and therapy remain sober after five years (Thomas, 2018). Agency (2017), 14.1 million adults ages 18 and older have Detox costs $2,200 on average and 17% remain sober after alcohol use disorder resulting in a$4,242 ($59.82 billion / five years (Juergens, 2019). Residential treatment costs 14.1 million) per capita cost for excessive alcohol use (not $3,100 and 21% remain sober after five years (Juergens, including workplace productivity). It was reported that 2019). Inpatient treatment costs $3,200 on average and 21% American’s spend on average $558 per year on alcohol remain sober after five years (Juergens, 2019). purchases (Bureau of Labor Statistics, 2019). Therefore, the The Centers for Disease Control and Prevention (2018) total cost per person (CPP) or savings would be $4,800 reported that the cost of excessive alcohol use in the United ($4,242 + $558). It was found that medication provided the States reached $249 billion in 2010. Seventy-two percent of most value treating alcoholism with an annual net benefit the costs resulted from losses in workplace productivity, (ANB) of $4,160. while the remaining 28% were for health care expenses for Programs SR Cost Cost/SR CPP ANB

Medication 20% $128 $640 $4,800 $4,160 Alcoholics Anonymous 10% $250 $2,500 $4,800 $2,300 Outpatient Drug Free 18% $1200 $6,666 $4,800 -$1,866 Detox 17% $2200 $12,491 $4,800 -$7,691 Residential Treatment 21% $3100 $14,761 $4,800 -$9,961 Inpatient Treatment 21% $3200 $15,238 $4,800 -$10,438

Smoking Cessation Program Costs and Success Rates Zyban has a 16% success rate. The average cost of Nicotrol The average cost for a stop smoking hypnotherapy session is is $420 for 168 cartridges, which will last for 28 days if one about $85 per session or $340for a four session stop uses six cartridges per day (Ghosal, 2019) and a six-month smoking program (Thompson, 2011). Twenty percent of the supply would cost around $2,500. Nicotine inhalers have an participants in the hypnosis group were abstinent at 12 18% success rate after twelve months (Hialmarson, Nilsson, months compared with 14% in the behavioural group Sjostrom and Wiklund, 1997). A month's supply of nicotine (Carmody, 2008). cost on average about $4.50 nasal spray purchased from an online retailer goes for $150, for 10 pieces of gum, the amount most people need to chew and a six-month supply could cost as much as $900. A daily to control nicotine withdrawal. After three months nicotine mouth spray typically has a 13.6% success rate after $405 ($4.50 * 90 days), most will be able to begin tapering one year (Tonnesen, Lauri, Perfect, Mann and Batra,2012). off the amount of gum they chew (Thompson, The Federal Drug Agency has ruled that lozenges, strips and 2011).Shiffman (2002) reported that only 8.4% in the OTC sticks that contain small pouches of for the mouth nicotine gum group were not smoking at the end of six are not smoking cessation aids. There’s no evidence that months. A month's supply of OTC nicotine patches these products can help a person quit smoking, but there is purchased from an online retailer is about $80 and roughly evidence that oral tobacco products like snuff and chewing $500 for a six month supply (includes shipping). Shiffman tobacco can cause cancer (Cancer.org, 2019).The average (2002) reported that only 9.2% of those using the OTC patch cost of acupuncture as a stop smoking technique ranged were not smoking after six months. from $50 to $100. However, this review did not find A 30-day supply of Chantix from an online retailer costs consistent evidence that acupuncture was an effective around $425 or around $1,275 for a three-month supply. smoking cessation technique. A laser therapy program costs There is currently no generic version of Chantix. Martin $349.This works like acupuncture, but instead of needles, it uses (2019) reported that Chantix had a 22% success rate (SR). A low-level lasers that won’t hurt the skin. Studies haven’t 90-day supply of a generic version of Zyban from an online confirmed that it works (Nazario, 2019). retailer costs around $100. According to Martin (2019)

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“Determination of Company Profitability and Value of Banks in Indonesia Based on Risk Profile, Capital Structure, Corporate Governance and Asset Structure”

Programs SR Cost Cost/SR CPP Benefit AP Zyban Generic 16% $100 $625 $3,650 $3,025 .17 Hypno-therapy 20% $340 $1,700 $3,650 $1,950 .47 Nicotine Gum 8.4% $405 $4,821 $3,650 -$1,171 1.32 Nicotine Patch 9.2% $500 $5,434 $3,650 -$1,784 1.49 Chantix 22% $1275 $5,795 $3,650 -$2,145 1.59 Nasal Spray 13.6% $900 $6,923 $3,650 -$3,273 1.90 Nicotine Inhaler 28% $2500 $8,928 $3,650 -$5,278 2.45 Acupuncture - $75 - $3,650 - - Strip, stick, Lozenges - $180 - $3,650 - - Laser Therapy - $349 - $3,650 - -

Health care costs for smokers in the United States are $2,056 see noticeable results within the first three to six weeks higher than for non-smokers (Dallas, 2019) and 34.3 million (Arroyo, 2017). McClaran (2003) found that a personal Americans 18 and older currently smoke in the United trainer significantly increased clients’ physical activity and States (CDC, 2019). Because smokers are more likely to die at 60% of study participants were successful. a younger age than non-smokers, annual pension costs were an The average cost of Lap-Band surgery is about $3,500 with average $296 less for each employee who smoked (Dallas, insurance and $15,000 without insurance (Quinlan, 2019). 2019). According to the Office of Management and Budget After 16 years, 62% of the 3,227 individuals treated with a (2019) the excise tax revenue from tobacco amounted to laparoscopic adjustable gastric band still had significant $13.8 billion in 2017 or about $402 ($13.8 billion / 34.3 weight loss (O’Brien, MacDonald, Anderson, Brennan & million) per smoker. A pack-a-day habit costs $188 Brown, 2013). per month or $2,292 per year (CDC, 2019). Therefore, the cost per person (CPP) or savings would be $3,650 {$2,056 + All prescription weight-loss drugs approved for long-term $2,292} – ($296 + $402)}. It was found that medication use produce significant weight loss compared to the placebo provided the most value reducing the prevalence of smoking (Mayo Clinic, 2018). Studies show that the addition of with an annual payback (AP) of .17 or about 2 months weight-loss medication to lifestyle changes results in greater (365*.17= 62 days). weight loss than lifestyle changes alone produce. Over the course of 12 months, one can expect a mean weight loss of 3 Weight Loss Program Costs and Success Rates to 7% of total body weight beyond that achieved with The American Society of Plastic Surgeons(2019)reported lifestyle changes alone (Mayo Clinic, 2018). that the average cost for liposuction in 2014 was $3,518. Phentermine (Adipex-P) is a popular drug used to decrease After liposuction, weight gain was reported in 43% (57% appetite that is available in a generic version (Mayo Clinic, success rate) of the responders, 79.7% would have the 2018). procedure again and 86% would recommend the procedure to family or friends (Broughton, Horton, Lipschitz, Kenkel, On-line retailers selling the Adipex-P quote an average retail Brown and Rohrich, 2006). price of $34.33 with an annual cost of $411.96. After stopping weight-loss medication people often gain back Two weekly personal training sessionswould cost $400 per some of the weight they lost. However, adopting healthy month or $4,800 annually. Those that work with a trainer lifestyle habits may help limit weight gain. The ten-year cost can expect on average to lose one to two pounds a week and would be $4,119.60.Phentermine based on 524 user ratings, was found to be 87% effective (Drugs.com, 2019). Programs SR Cost Cost/SR CPP Benefit AP Weight Loss Drugs 87% $4110 $4,724 $1,429 -$3,295 3.30 Liposuction 57% $3518 $6,172 $1,429 -$4,743 4.31 Personal Trainer 60% $4800 $8,000 $1,429 -$6,571 5.59 Lap Band 62% $15000 $24,193 $1,429 -$22764 22.76

The National Center for Health Statisticsestimated in 2015- the United States. Therefore, the cost per person (CPP) for 2016 in the U.S., 39.8% of adults aged 20 and over were one that is obese or the savings in medical expenses would obese (including 7.6% with severe obesity) and that another be $1,429 per year (Antonelli, Maalouf, Pearle &Lotan, 31.8% were overweight (Fryar, 2018). Approximately $147 2014). It was found that medication provided the most value billion is added medical expenses per year due to obesity in

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“Determination of Company Profitability and Value of Banks in Indonesia Based on Risk Profile, Capital Structure, Corporate Governance and Asset Structure” reducing the prevalence of obesity with an annual payback randomized in a peer support intervention versus cognitive (AP) of 3.3 years. therapy. Depression Treatment Program Costs and Success Rates The cost to join a weekly support group can cost as little as Antidepressants improved symptoms in about 20 out of 100 $15 per week ($60 per month) or $180 (three months). (NCBI, 2015) and a generic antidepressant can be purchased Goyal (2014) reported that mindfulness meditation may be for as little as $4 per month or $48 per year (Westra, 2010) just as effective as medication when it comes to the Research shows that psychotherapy for depression is treatment of depression, and no third-party cost is associated as effective as antidepressant medications during the with engaging in mindfulness. Likewise, exercise enhances treatment period (Westra, 2010). However, seeing a the action of endorphins circulating throughout the body psychotherapist costs around $100 per session, so a six improving natural immunity and is as effective at reducing session treatment program spread over three months would milddepression as antidepressant medications (Harvard cost around $600, which is about 12 times the annual cost Health Letter, 2013). for generic antidepressant medication. Pfeiffer, Heisler,

Piette, Rogers and Valenstein (2010) reported no significant difference in depression outcomes between those

Programs SR Cost Cost/SR CPP Benefit AP Exercise 20% $0 $0 $4,382 $4,382 .00 Meditation 20% $0 $0 $4,382 $4,382 .00 Medication 20% $48 $240 $4,382 $4,142 .05 Support Groups 20% $180 $900 $4,382 $3,482 .20 Psycho-therapy 20% $600 $3,000 $4,382 $1,382 .68

The amount spent to treat depressive disorders in the United medication, which had an annual payback (AP) of .05. States is $71 billion (Dieleman, Baral& Birger, 2016), and Medication provided the most value reducing the prevalence 16.2 million adults in the United States have at least one of obesity with an annual payback (AP) of 3.3 years. major depressive episode in a given year (Koskie, 2018). Harris (2016) reported that 119 million people in the United Therefore, the cost per person (CPP) for depressive States use prescription drugs. However, manyAmericans are disorders in the United States is $4,382 per person ($71 opposed to the use of medication so they rely more heavily billion / 16.2 million). It was found that exercise and on natural remedies to treat disease and addiction. meditation provided the most value treating mild depression Fortunately for them, many treatments don’t require followed by medication, which had an annual payback (AP) medication and in some cases provide more value. For of .05. example, exercise and meditation were found to have

provided more value than medication when it came to CONCLUSIONS treating mild depression. The causes of obesity, addiction, and depression are complex and beyond the scope of this paper. Accordingly, Not every type of addiction or disease is preventable, but the purpose of this study was not meant to delve into the since these health concerns cost the United States billions complexities of these health issues but to provide a broad each year, more should be invested into treatments and and comparative overview of the average and typical costs education programs that provide value to help newer associated with their treatment, understanding full well that generations veer away from unhealthy lifestyles. Effective treatments differ greatly in price depending on the type and programs could potentially decrease the costs that are being severity of the obesity, addiction, and depression. Thus, spent each year on treatments and healing remedies because more in-depth research should be conducted on the costs of addiction. associated with each of these specific health issues. REFERENCES Based on this study’s findings, for the most part getting 1. Addiction Center (2019). Addiction Statistics - Facts on treatment does provide value. Medication provided the most drug and alcohol use, value treating alcoholism with an annual payback (AP) of https://www.addictioncenter.com/addiction/addiction- .16 or about two months (365*.16= 58.4 days). Medication statistics/# also provided the most value reducing the prevalence of 2. The American Society of Addiction Medicine (2015). smoking with an annual payback (AP) of .17 or about two Relevance of Twelve-Step recovery in 21st century, months (365*.17= 62 days). Exercise and meditation Addiction Medicine. provided the most value treating depression followed by

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